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Title: Hybrid abdominal robotic approach with conventional transanal total mesorectal excision (TaTME) for rectal cancer: feasibility and outcomes from a single institution.
Austin Authors: Nikolic, Amanda;Waters, Peadar S;Peacock, Oliver;Choi, Colin Chan-Min;Rajkomar, Amrish;Heriot, Alexander G;Smart, Philip ;Warrier, Satish
Affiliation: Department of Surgery, Eastern Health, 5 Arnold Street, Box Hill, Melbourne, VIC, 3128, Australia
The Surgery Centre, Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
Colorectal Surgery Unit, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
The Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia
General Surgery and Gastroenterology Clinical Institute, Epworth Healthcare, Richmond, Australia
Issue Date: Aug-2020 2019-10-17
Publication information: Journal of Robotic Surgery 2020; 4(4): 633-641
Abstract: Total mesorectal excision (TME) is currently recognised as the standard of care for patients with rectal cancer. Complete TME is known to be associated with lower rates of recurrence. Robotic and endoscopic TaTME approaches are reported to offer excellent proximal and distal rectal dissection into the TME plane, however, combining both approaches in a hybrid procedure could potentially optimise visualisation of the dissection plane and confer improved circumferential and distal margin rates. The aim of this study was to analyse the feasibility of a hybrid robotic abdominal approach with conventional TaTME for rectal cancer. Furthermore, pathological and patient outcomes were assessed. A review of prospectively maintained databases was undertaken to assess all patients undergoing robotic TME surgery for rectal tumours from August 2016 to October 2017. Patient demographics, tumour characteristics and outcomes were collated from patient charts and hospital databases. All patients underwent a modified Cecil approach after multidisciplinary team discussion. Eight patients (7 male, 1 female) underwent a combined hybrid approach with a median age of 60¬†years (range 47-73) and BMI of 29.5 (range 20-39.1) kg/m2. Median distance from the anorectal junction (ARJ) was 7.5 (range 4-13) cm. Six patients underwent neoadjuvant treatment with chemoradiotherapy. Patients had a median length of stay (LOS) of 9 (range 4-33) days. There were no intra-operative complications encountered and no patients required a conversion to an open procedure. Complications included one anastomotic leak and one presacral collection. All patients had a complete TME with RO resection with a median number of lymph nodes harvested was 22 (range 6-37) lymph nodes. This hybrid technique is a feasible, practical and operatively favourable approach to rectal cancer surgery with initial pathological outcomes and complication profile equivalent to other approaches.
DOI: 10.1007/s11701-019-01032-y
ORCID: 0000-0003-2947-9206
PubMed URL: 31625075
Type: Journal Article
Subjects: Hybrid surgery
Pelvic malignancy
Rectal cancer
Robotic surgery
Sphincter preservation
Total mesorectal excision
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